Admissions & Discharges Office – Team Lead at Valley Hospital

key Responsibilities

Insurance/corporate Pre-authorisation & Authorization Management


Oversee and review all outpatient pre-authorisation requests submitted to insurance/corporate companies including Social Health Authority (SHA), ensuring accuracy, completeness, and timeliness
Supervise the end-to-end inpatient authorization process from initial submission through to approval, including management of pending cases and escalation of disputes
Maintain up-to-date knowledge of payer policies, SHA protocols, and benefit schedules to guide the team on correct claim coding and authorization submission
Monitor authorization turnaround times and flag delays that may affect patient care or revenue flow, escalating to clinical or finance teams as needed
Liaise directly with insurance/corporate case managers/contacts and SHA relationship officers to resolve disputes, obtain extensions, and manage complex or high-cost authorizations


Admissions Management


Supervise the admission of all referred patients from external healthcare facilities, ensuring proper documentation, clinical handover protocols, and bed allocation are coordinated promptly
Manage the conversion process for outpatients requiring inpatient admission, ensuring a seamless transition without disruption to the patient experience or clinical workflow
Verify completeness of all admission documentation including referral letters, patient identification, insurance/corporate eligibility checks, and deposit or guarantee letters where applicable
Coordinate with clinical departments, nursing, and housekeeping to manage bed availability and expected admissions, minimizing patient waiting times
Ensure all admissions are captured accurately and in real time on the Hospital Management Information System (HMIS)


Discharge Coordination


Oversee the discharge process to ensure timely clearance of patients, including final billing reconciliation, insurance/corporate sign-off, and collection of outstanding patient balances
Coordinate with nursing, pharmacy, and finance teams to resolve pre-discharge holds and confirm discharge summaries are complete before patient departure
Monitor average length-of-stay data and work with clinical teams to reduce avoidable delays in discharge


Team Leadership & Department Oversight


Directly supervise and performance-manage all staff within the Admissions & Discharges Office across all shifts, including weekends and public holidays
Prepare duty rosters ensuring adequate coverage at all times; manage leave, absenteeism, and overtime within approved thresholds
Identify training needs and facilitate on-the-job coaching and structured development to maintain team competency and service quality
Conduct regular team briefings and performance reviews, documenting outcomes and escalating HR matters as appropriate
Foster a culture of accuracy, accountability, and patient-centred service


Metrics, Reporting & Analytics


Track and report on key performance indicators including pre-authorisation approval rates, denial/rejection rates, admissions volumes, OP-to-IP conversion rates, and discharge turnaround times
Prepare daily, weekly, and monthly operational reports for the Head of Patient Services and senior management
Identify trends and recommend operational or policy changes to improve authorization approval rates and reduce admission delays


Process Improvement & Compliance


Implement process changes to reduce authorization errors and shorten the patient admission-to-discharge cycle
Ensure compliance with healthcare regulations, insurance/corporate contractual obligations, SHA requirements, and internal administrative controls
Collaborate with clinical, billing, and finance teams to close gaps at the point of patient registration, authorization, and discharge documentation


Key Competencies


Analytical thinking and attention to detail
Strong communication and negotiation skills
Leadership and team development
Process improvement orientation
Patient-centred service mindset and understanding of healthcare operations


Requirements




Diploma or Bachelor's degree in Health Records & Information Management, Business Administration (Healthcare), Nursing, or a related field
Minimum 3 years' experience in a hospital front office, admissions, or medical billing environment.
Proficiency in a Hospital Management Information System (HMIS); familiarity with SHA and private insurer authorization platforms
Working knowledge of Kenya's Social Health Insurance, private insurance/corporate framework (SHA) and insurance/corporate panel processes
Training in medical billing or insurance/corporate claims processing is an added advantage